What are the responsibilities and job description for the Outpatient HCC Clinical Documentation Specialist position at Redeemer Health?
OVERVIEW:
CONNECTING TO MISSION:
Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success including education assistance, scholarships, and career training. With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job. You’ll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention. We look forward to being a part of your professional journey. We invite you to apply today.
SUMMARY OF JOB:
This position will assist providers in highlighting clinically relevant information needed towards the recapture or identification of Hierarchical Condition Categories (HCCs). HCCs directly impact the patient risk-adjusted profile (RAF score) calculated by the associated risk-adjusted plans.
The HCC Risk-Based Coder is responsible for completing pre-visit chart reviews for scheduled patients. Pre-visit reviews are intended to identify documentation opportunities for the provider to recapture previously documented HCCs diagnoses or new HCCs or suspect conditions not previously captured that are identified by reviewing past medical records. The HCC Risk-Based Coder coordinates with Professional/Outpatient Coding Auditor & Educator and other colleagues from the Outpatient CDI Program on education and training geared toward improving coding, billing and documentation practices.
CONNECTING TO MISSION:
All individuals, within the scope of their position, are responsible for performing their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in all interactions with patients, residents, families and one another in the services we provide.
RECRUITMENT REQUIREMENTS:
- Minimum of 3 years inpatient and/or outpatient coding experience. Will consider experienced clinical caregivers/managers and/or revenue management/revenue cycle professionals
- General knowledge of coding/classification systems appropriate for outpatient and/or inpatient, APC and/or DRG and Hierarchical Condition Categories (HCCs) prospective payment system and reimbursement structures.
- Knowledge of CMS, Medicaid and third party payer coding, billing and compliance regulations required (MS-DRG, ICD-10-CM, HCPCS, CPT, Modifiers, etc.)
- Extensive clinical knowledge and understanding of pathophysiology
- Demonstrated strong interpersonal relationships to effectively communicate with all levels within the organization
- Good problem solving and investigative skills.
- Proven organizational skills to initiate and maintain efficient work flow.
- Ability to organize and coordinate multiple functions and tasks.
- Ability to use Microsoft Excel and Power Point Presentations and databases such as Power - BI (i.e. Data Analytics Management system).
- Experience with 3M Encoder and computerized abstracting system.
- Ability to utilize multiple hospital application systems (Soarian Clinical/Financial, Athena, inovalon, etc.).
- Ability to work with minimum supervision at a high level of motivation and initiative while being entrepreneurial, creative and results oriented. Capacity to work independently.
LICENSE AND REGULATORY REQUIREMENTS:
Must possess an Associate/Diploma Degree in Health Information Technology (HIT) or Medical Assisting or Nursing (RN or LPN), or/and advanced degree in Health Information Management or the medical field.
- Must possess one of the below:
- Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- Certified Coding Specialist (CCS).
- Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Professional (CDIP).
- Or 3-5 years of auditing experience or other employment that required auditing and training for Inpatient and Outpatient Hospital Medical coding.
- Registered Nurse (RN), Licensed Practical Nurse (LPN)
Redeemer Health is an equal opportunity employer. We prohibit discrimination in employment due to race, color, gender, religion, creed, national origin, age, sex, sexual orientation, gender identity or expression, disability veteran status or any other protected classification required by law.
